Radiotherapy Alone vs Radiotherapy With Concurrent Chemoradiotherapy and Survival of Patients With Low-Risk Nasopharyngeal Carcinoma

Abstract

To the Editor We have several comments about the recent study 1 that found that intensity-modulated radiation therapy (IMRT) alone was not inferior for 3-year failure-free survival compared with concurrent chemoradiotherapy in patients with lowrisk nasopharyngeal carcinoma (NPC).First, this study used triweekly cisplatin. Prior research has shown that concurrent chemoradiotherapy with weekly cisplatin resulted in fewer adverse effects than triweekly cisplatin. 2 Second, the use of induction chemotherapy was not specified in this study. The role of induction chemotherapy is unclear in stage II and T3N0M0 NPC. Use of induction chemotherapy with radiotherapy may result in improved survival compared with radiotherapy. 3 Thus, radiotherapy alone may not be the standard treatment for low-risk NPC. Third, this study did not require the use of positron emission tomography (PET) for initial staging of NPC. Because PET is good at detecting lymph nodes, 4 failure to make PET mandatory in this study may have resulted in lower staging accuracy. Fourth, this study did not specify the use of image-guided radiotherapy, which is a method of radiation therapy that has the potential to reduce setup errors in patient positioning and improve adverse effects, such as preserving saliva production. 5

Analysis of the Effect of Radiotherapy Skin Protective Agents on Skin Reactions in Patients with Nasopharyngeal Carcinoma Radiotherapy

“…At this time, patients would need to receive radiotherapy. During radiotherapy, skin reactions may occur, which is a manifestation of treatment toxicity, with symptoms such as local pain and itching [2] . As symptoms worsen, adverse conditions such as blisters and ulcers can be observed, which reduces the comfort level and even affects the outcome of radiotherapy.…”